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P200 First utilization of the concurrent version of the AEP in Portugal for evaluating appropriateness of admissions and stays: a pilot study
S88
Abstracts
Conclusions: In patients having a fever abnormal white cell count and high ALAT predictors of severe outcome.
I European
of unknown and bilirubin
P199 Are we providing adequate information and support percutaneous endoscopic gastrostomy (PEG) tubes? K. Ali, A. Ajaj, A. Alhadid, R. Roy, M. Cox (Walsall,
Journal
of Internal
origin, anaemia, are independent
to recipients Wakejield,
of UK)
Introduction; The decision to insert a PEG tube is complex and requires a multidisciplinary team. Yet there are no national guidelines for the timing of insertion, or the time-scale for future swallowing reassessment. Studies have shown that those who coped best were well informed and supported patients and carers. The aim of this study was to judge the level of information (verbal and written), and support provided to PEG recipients. Method: 26 pairs of patients and carers were interviewed, initially at hospital, and by phone a month later. Patients were the respondents unless dysarthric or cognitively impaired. Using a questionnaire we explored the recipients knowledge of contactable persons if complications occur, and swallowing reassessment availability. Results: 26 patients (13 male) had PEG tubes. 54% were stroke victims, a further 8% had subarachnoid haemorrhage, 12% cancer (oesophagus, larynx and tongue), 8% cerebral palsy, 4% Alzheimer’s disease, and 14% had other causes. Mean age was 71.5 years (SD? 14 years). 15% of patients developed nausea, vomiting and diarrhoea within one month. One blocked PEG tube was replaced. 23% of patients died within 6 weeks. 46% were discharged home, while 31% went to nursing homes. Of the people who went home; 17% were unaware of any complications and were not given printed information, 67% thought that PEG tube was permanent and were unaware of swallowing reassessment dates, whilst 17% did not know whom to contact if complications arise. Conclusions: A substantial number of PEG tube recipients were inadequately informed of complications, and available support measures. We recommend better patient education as an important component of PEG management.
P200 First utilization of the concurrent version evaluating appropriateness of admissions L. Monteiro, J. Rodriguez-Vera, L. Arez, Grade, I. Duarte, R. Tome (Portimao, P)
of the AEP in Portugal for and stays: a pilot study N. Vieira, T. Taveira, M.J.
Zntroduction: The AEP (Appropriateness Evaluation Protocol) is a tool to evaluate the overuse of the hospitalization resources. It needs a retrospective review of large amount of clinical records. The concurrent version of the AEP offers the possibility of getting an instant perspective of appropriateness. Objective: To evaluate the percentage and causes of inappropriate admissions and stays in an internal medicine ward using the concurrent version of the AEP. Method: Application of the concurrent version of the AEP to the 22 patients interned in Internal Medicne Section I. Six doctors not responsible for the admission and stay evaluated the appropriateness with the support of an experimented user of the AEP. Demographical (gender, age), clinical (group of pathology and readmission) and structural parameters (time from emergency room to the ward) were also analyzed. Results: The average age of the patients was 70.71 years (SD 21.04). 54.5% were female. The most common group of pathology was respiratory (27.2%). 9.1% of the patients had been admitted more than once in the last year. The average stay was 9.90 days. 63.6% remained in the emergency department more than 24 hours before the admission in the lntemal Medicine ward. All the clinical records reviewed fullfilled criteria for appropriateness of admission. 27.3% of the stays were inappropriate.
Medicine
14 (2003)
SI -S159
The most common cause for inappropriateness was the absence of written orders about the patients who were discharged that day. The most common cause for appropriateness of stay was need for intravenous medication. Conclusions: We obtained a percentage of inappropriateness of stays similar to other studies. The high appropriateness of the admissions may be related with a high comorbidity of our patients. The concurrent version of the AEP allows the possibility of rapidly obtaining a view of the causes of overuse of hospitalization resources.
P201 Homozygosity for factor V Leiden - a rare J. Moreira, E. Eiras, J. Brandao, 0. GonGalves,
case M. Gongalves
(Porto,
P)
Factor V Leiden and prothrombin gene mutation are the two major causes of venous thrombosis. Homozygoty for factor V Leiden is a rare mutation with a very high thrombotic risk. The authors present a case of a 21-year-old man, Caucasian, assymptomatic. Two months before hospital admission he develops progressive dyspnea, edema of the lower extremities and increase in abdominal length. At hospital admission we come across with a severe ill patient. Laboratory tests showed LDH 2 times normal value (2 X N), AST 1.5 X N and ALT 2 X N. Abdominal CT showed: inferior vena cava thrombosis from supra-hepatic to iliac veins, ascites and pleural effusion. Transesophageal echocardiogram showed: large mass in the right atrium extending from the inferior vena cava with significant impairment of bicuspid function. Peritoneal effusion analysis showed a transudate. The patient began heparin but little improvement was noticed. Further exams revealed homozygoty for factor V Leiden and prothrombin gene mutation. The authors had a multidisciplinary meeting with vascular and thoracic surgeons and no further treatment was suggested. The patient died two months after admission due to a massive hematemesis.
P202 A computer program that supports the initial assessment sions to an acute medical unit - results of a pilot study K. Hameed, J. Kellett (Co. Tipperary, IRL)
of admis-
Background: A medical assessment program (MAP) was developed to support the initial assessment of patients to an acute medical unit. The program requires the admitting physician to enter the patient’s vital signs as well as symptoms, physical findings, past and drug history relevant to the presenting complaint. From this information a ‘print-out’ summarises the historical and physical findings and provides an investigation and treatment plan. Methods: 1380 patients were admitted between August 28, 2002 to February 15, 2003. Ten doctors in-training tested the MAP on 299 (22%) of these patients. Results: Data entry took 13.7221.9 minutes (median time 8.8 minutes). Those patients whose data took longer than the median time of 8.8 minutes to enter were older (66.3217.8 vs. 61.3k21.4 years, p40.004) and had a longer length of in-hospital stay (6.556.0 vs. 5.5k5.6 days, p
Abstracts
Conclusions: In patients having a fever abnormal white cell count and high ALAT predictors of severe outcome.
I European
of unknown and bilirubin
P199 Are we providing adequate information and support percutaneous endoscopic gastrostomy (PEG) tubes? K. Ali, A. Ajaj, A. Alhadid, R. Roy, M. Cox (Walsall,
Journal
of Internal
origin, anaemia, are independent
to recipients Wakejield,
of UK)
Introduction; The decision to insert a PEG tube is complex and requires a multidisciplinary team. Yet there are no national guidelines for the timing of insertion, or the time-scale for future swallowing reassessment. Studies have shown that those who coped best were well informed and supported patients and carers. The aim of this study was to judge the level of information (verbal and written), and support provided to PEG recipients. Method: 26 pairs of patients and carers were interviewed, initially at hospital, and by phone a month later. Patients were the respondents unless dysarthric or cognitively impaired. Using a questionnaire we explored the recipients knowledge of contactable persons if complications occur, and swallowing reassessment availability. Results: 26 patients (13 male) had PEG tubes. 54% were stroke victims, a further 8% had subarachnoid haemorrhage, 12% cancer (oesophagus, larynx and tongue), 8% cerebral palsy, 4% Alzheimer’s disease, and 14% had other causes. Mean age was 71.5 years (SD? 14 years). 15% of patients developed nausea, vomiting and diarrhoea within one month. One blocked PEG tube was replaced. 23% of patients died within 6 weeks. 46% were discharged home, while 31% went to nursing homes. Of the people who went home; 17% were unaware of any complications and were not given printed information, 67% thought that PEG tube was permanent and were unaware of swallowing reassessment dates, whilst 17% did not know whom to contact if complications arise. Conclusions: A substantial number of PEG tube recipients were inadequately informed of complications, and available support measures. We recommend better patient education as an important component of PEG management.
P200 First utilization of the concurrent version evaluating appropriateness of admissions L. Monteiro, J. Rodriguez-Vera, L. Arez, Grade, I. Duarte, R. Tome (Portimao, P)
of the AEP in Portugal for and stays: a pilot study N. Vieira, T. Taveira, M.J.
Zntroduction: The AEP (Appropriateness Evaluation Protocol) is a tool to evaluate the overuse of the hospitalization resources. It needs a retrospective review of large amount of clinical records. The concurrent version of the AEP offers the possibility of getting an instant perspective of appropriateness. Objective: To evaluate the percentage and causes of inappropriate admissions and stays in an internal medicine ward using the concurrent version of the AEP. Method: Application of the concurrent version of the AEP to the 22 patients interned in Internal Medicne Section I. Six doctors not responsible for the admission and stay evaluated the appropriateness with the support of an experimented user of the AEP. Demographical (gender, age), clinical (group of pathology and readmission) and structural parameters (time from emergency room to the ward) were also analyzed. Results: The average age of the patients was 70.71 years (SD 21.04). 54.5% were female. The most common group of pathology was respiratory (27.2%). 9.1% of the patients had been admitted more than once in the last year. The average stay was 9.90 days. 63.6% remained in the emergency department more than 24 hours before the admission in the lntemal Medicine ward. All the clinical records reviewed fullfilled criteria for appropriateness of admission. 27.3% of the stays were inappropriate.
Medicine
14 (2003)
SI -S159
The most common cause for inappropriateness was the absence of written orders about the patients who were discharged that day. The most common cause for appropriateness of stay was need for intravenous medication. Conclusions: We obtained a percentage of inappropriateness of stays similar to other studies. The high appropriateness of the admissions may be related with a high comorbidity of our patients. The concurrent version of the AEP allows the possibility of rapidly obtaining a view of the causes of overuse of hospitalization resources.
P201 Homozygosity for factor V Leiden - a rare J. Moreira, E. Eiras, J. Brandao, 0. GonGalves,
case M. Gongalves
(Porto,
P)
Factor V Leiden and prothrombin gene mutation are the two major causes of venous thrombosis. Homozygoty for factor V Leiden is a rare mutation with a very high thrombotic risk. The authors present a case of a 21-year-old man, Caucasian, assymptomatic. Two months before hospital admission he develops progressive dyspnea, edema of the lower extremities and increase in abdominal length. At hospital admission we come across with a severe ill patient. Laboratory tests showed LDH 2 times normal value (2 X N), AST 1.5 X N and ALT 2 X N. Abdominal CT showed: inferior vena cava thrombosis from supra-hepatic to iliac veins, ascites and pleural effusion. Transesophageal echocardiogram showed: large mass in the right atrium extending from the inferior vena cava with significant impairment of bicuspid function. Peritoneal effusion analysis showed a transudate. The patient began heparin but little improvement was noticed. Further exams revealed homozygoty for factor V Leiden and prothrombin gene mutation. The authors had a multidisciplinary meeting with vascular and thoracic surgeons and no further treatment was suggested. The patient died two months after admission due to a massive hematemesis.
P202 A computer program that supports the initial assessment sions to an acute medical unit - results of a pilot study K. Hameed, J. Kellett (Co. Tipperary, IRL)
of admis-
Background: A medical assessment program (MAP) was developed to support the initial assessment of patients to an acute medical unit. The program requires the admitting physician to enter the patient’s vital signs as well as symptoms, physical findings, past and drug history relevant to the presenting complaint. From this information a ‘print-out’ summarises the historical and physical findings and provides an investigation and treatment plan. Methods: 1380 patients were admitted between August 28, 2002 to February 15, 2003. Ten doctors in-training tested the MAP on 299 (22%) of these patients. Results: Data entry took 13.7221.9 minutes (median time 8.8 minutes). Those patients whose data took longer than the median time of 8.8 minutes to enter were older (66.3217.8 vs. 61.3k21.4 years, p40.004) and had a longer length of in-hospital stay (6.556.0 vs. 5.5k5.6 days, p